Characterization of the HIV PrEP Pathway in the United States Military Health System

Abstract

The use of tenofovir-emtricitabine for HIV pre-exposure prophylaxis (PrEP) has been over 99% effective in preventing HIV infection. However, despite its availability in the Military Health System (MHS) since 2014, HIV incidence remains higher among active-duty service members (ADSMs) compared to the general population. This study aimed to assess the PrEP clinical pathway in the military from 2021-2023, focusing on prescribing patterns and identifying gaps in continuity of care. We conducted a retrospective cohort study using data from the Defense Medical Surveillance System (DMSS) and the Armed Forces Health Surveillance Division (AFHSD). The study included ADSMs aged 18-55 who were at risk for HIV and received a new PrEP prescription during the study period. Excluded were individuals with less than 6 months of active service, prior HIV, non-sexually active individuals, and those with prior STIs or PrEP prescriptions. Key events measured were time to PrEP prescription, initiation, discontinuation, and restart. Results indicated that 72.6% received a PrEP prescription within a year of risk identification, with a median time to prescription of 215 days. Roughly 45% discontinued PrEPat some point, many after just one prescription. MSM individuals had a longer median time to prescription compared to non-MSM but were more likely to restart PrEP after discontinuation. The study highlighted significant gaps in PrEP initiation and high discontinuation rates among ADSMs. These findings underscore the need for targeted interventions to improve PrEP uptake and adherence, particularly among high-risk groups, to reduce HIV incidence in the military.